277 vs 277CA

277CA -The Claims Acknowledgement (277-CA) in 5010 replaced proprietary error /pre-pass report in 4010A1. This report is generated after your 837 (I or P) claim file has been received and has also received the TA1 Interchange Acknowledgement and then the 999 Functional Acknowledgement. The 277CA acknowledges all accepted or rejected claims in the 837 file. After your claims in the 837 file are accepted at the 277CA level, they forwarded to the Payers adjudication system where policy edits are applied and then payment or denial is determined and returned to the payer via 835 or paper remittance advice.

277 -The 277 transaction is the response to the 276 transaction submitted by a provider, recipient of health care products or services or their authorized agent. The 276 transaction is a request for the status of a health care claim. The 277 transaction is used by health care providers or authorized agent to get the status of a health care claim. This transaction NOT is a replacement of 835 transactions or paper remittance advice, therefore is not used for account payment posting. The 277 may be solicited or unsolicited. Providers have a number of non-EDI options to obtain claim status. The non-EDI options are designed for the “single” use requests and responses. They are not designed for organizations who wish to reduce costs and increase overall efficiency. That is why the electronic 276/277 process is recommended. Using the 276/277 transaction eliminates the need for manual entry of individual queries or calls to a payer to obtain this information.

 

Differences Between 277CA and 277
277CA 277
What triggers transactions? Payer generated when 837 passes first level edits via 999 transaction Payer generated response to the 276 transaction
Which comes first? 277CA
What type of status? EDI – Accepted or Rejected Adjudication – Pending, Paid, Denied, etc
How to interpret? If accepted, claim will be forwarded for adjudication. If rejected, claim needs to be re-billed via 837 Paid, Denied or Pending
835 Payment Advice? Yes, if accepted Yes, if Paid or Denied

 

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